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Clinical outcome of elderly peritoneal dialysis patients with assisted care in a single medical centre: A 25 year experience
Author(s) -
Cheng ChiHung,
Shu KuoHsiung,
Chuang YaWen,
Huang ShihTing,
Chou MingChih,
Chang HorngRong
Publication year - 2013
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12090
Subject(s) - medicine , hazard ratio , peritoneal dialysis , proportional hazards model , retrospective cohort study , confidence interval , cohort , dialysis , peritonitis , incidence (geometry) , intensive care medicine , physics , optics
Aim Peritoneal dialysis ( PD ) is an alternative treatment for elderly patients with end‐stage renal disease ( ESRD) . In T aiwan, non‐professional personnel are employed to provide assisted care for elderly patients. Whether assisted care is appropriate for elderly patients is unknown. The aim of this paper is to evaluate the outcomes of assisted care in a single centre. Methods This is a retrospective cohort study in a single medical centre. The outcomes were derived from the assessment of patient survival, technique survival and peritonitis incidence between self‐care patients and assisted‐care patients. Results From 1984 to 2010, there were 138 elderly PD patients at T aichung V eterans G eneral H ospital, of which 70% were assisted‐care patients and 30% self‐care patients. The mean duration of PD survival was 49.2 months in self‐care patients, which was significantly longer than the 17.0 months of assisted‐care patients ( P < 0.05). Using the multivariate C ox proportion regression model to adjust for risk factors, it was found that self‐care patients had a lower risk in both patient survival ( H azard R atio 0.15; 95% confidence interval ( CI ) 0.2–0.94, P < 0.05) and technique survival ( H azard ratio; 0.11, 95% CI 0.1–0.9, P < 0.05). Fluid overloading was the major cause of technique failure in assisted‐care patients. Type of assistance was not a risk factor for PD ‐related peritonitis. Conclusion Our elderly assisted care had patients had a poorer survival and technique survival rates than those of the self‐care patients. We argue that this is because early recognition of medical deterioration and early medical intervention are necessary for a better outcome for elderly PD patients.